Part 16

While Dr. Semple's reports do not precisely state it, I think we may safely infer a _sense of impending dissolution_ in cases I, IV and V. The girl exclaimed she "would lose her breath and die;" the man in case I "expressed in words" "the deep anxiety he felt;" the woman in case IV was found "apparently moribund" with "gasping respiration," and therefore incapable of speech, but who can doubt that she had _a sense of impending dissolution?_

ISOLATED SYMPTOMS.

_Numbness of the arm, 1._ _Black vomit, 1._ _Alvine evacuations similar to the black vomit, 1._ _Sinking sensation at epigastrium, 2._ _Respiration only occasional--gasping, 4._

It must be admitted that many of our accepted provings cannot as well bear a similar test.

III.

There is another feature that the believer in the law of similars should find no insuperable difficulty in accepting as a criterion of the validity of a proving, namely: _the similarity of the drug symptoms to certain disease symptoms_. I am not ready to believe that drug symptoms are only the result of a "fortuitous concourse of atoms," nor can I for one moment imagine that they are the product of blind and aimless chance. I plainly discern in them the result of law, and I am wholly unable to conceive of existing law without the absolutely necessary _pre_-existing law maker. The consequent must have its antecedent. Therefore, in a drug symptom I see a purpose, and by the light of the law of similars I find the purpose of a drug symptom in an analogous disease symptom--they answer to each other as face unto face in the refiner's silver--and behind and beyond them both is another purpose, of wisdom inscrutable, of love unfathomable. In a word, my reader, the problem of the visible universe forces upon me the alternative that weighed upon Marcus Aurelius--"either gods, or atoms." With atoms only I cannot account for law; with God and in God both atoms and law find a meaning and a purpose.

If I were submitting these convictions, or, if you will, this "working hypothesis," to a Sir Thomas Browne, or a William Harvey, or a Thomas Sydenham I should feel no momentary hesitation; as it is, I can only hope that the spirit that filled these worthies is not extinct in days when the "spiritual colic" that disordered an imaginary _Robert Elsmere_ is thought to disturb the eternal Verities. I much doubt if they who mistake an eclipse for an annihilation will get any good from this poor pen of mine.

The resemblance between the symptoms of angina pectoris and the effects of the poison of _Latrodectus mactans_ are so striking as to justify the presentation of a comparison; and it is hoped that physicians of wide reading will pardon what may seem to them a piece of supererogation for the sake of many a humbler practitioner whose opportunities have not been so happy. At the same time, the widest reader must admit that he has not found any one authority who has given a complete picture of angina pectoris. Nor is it essential that such an all-including "composite" shall now be presented; on the contrary, we shall offer only salient points substantiated by observers of the highest order.

It will be well to start from an authority whose scholarship has never been excelled--_Copland_. Of all our medical writers he may be called the _Great Definer_--his readers will know what that means.

"_Acute constricting pain at the lower part of the sternum, inclining to the left side, and extending to the arm, accompanied with great anxiety, difficulty of breathing, tendency to syncope, and feeling of approaching dissolution._"

Copland presents a group of constants, and, for a terse definition, has well covered the principal phenomena. As variants he has omitted the pulse and the surface temperature. He errs on the side of dogmatism in defining the character of the pain as "constricting;" "aching, burning, or indescribable," and "generally attended with a sense of constriction" is more in accordance with the actual condition. Of Copland's seven constants, Case 4 presents an analogue for each in symptoms IX., V., III., VIII., XII., and the "tendency to syncope," which is not included in our table because Dr. Semple did not put the fact in express words. If to this group we add the _thready pulse_ and _cold skin_, we shall have "covered" nine of the most prominent symptoms of angina pectoris; a pathological "composite" with a most striking pathogenetic _similimum_.

But all the elements of Copland's group are not of equal importance; two of them, at least, are pathognomonic. "The two constituent elements of the paroxysm," says Latham, are "the sense of dissolution and the pain." "Pain with one awful accompaniment may be everything." "This mixture of the sharpest pain with a feeling of instant death." According to Fothergill "the two prominent subjective phenomena are pain in the chest and a sense of impending death." Eulenburg and Guttmann include another element: "We regard the substernal pain, the feeling of anxiety, and the disturbance of the heart's action, as the essential symptoms of angina pectoris." Romberg notes the companionship of these two elements: "The patient attacked with angina pectoris is suddenly seized with a pain under the sternum in the neighborhood of the heart, accompanied by a sense of anxiety so intense as to induce a belief in the approach of death."

We have laid the emphasis of these various citations on the "essential symptoms" in order to assert, with equal emphasis, that their analogues occur in not only one case of _Latrodectus mactans_ poisoning. The præcordial pain is noted in Cases 1, 3, 4 and 5, and the sense of impending dissolution in Cases 1, 4 and 5. And that disturbance of the heart's action which Eulenburg and Guttmann consider an essential element is found in Cases 1, 2, 4 and 5; so that the _tout ensemble_ presented by Case 4 is corroborated.

Another important element, though it is one subject to variations, is the direction of the extension of the pain. It most generally extends to the left axilla, and down the arm to the fingers; as variations it sometimes affects the right axilla and the back of the head. In Cases 1 and 4 the spider poison followed the direction of the disease, and in Cases 4 and 5 it also affected the back of the head. In Case 1 it produced the numbness of the arm and hand that is sometimes observed in the diseases.

Copland includes "difficulty of breathing" amongst the elements of angina pectoris. Trousseau does not regard this difficulty as real. "Although patients think they are going to be suffocated during a paroxysm, the chest is normally resonant on percussion, and if it be auscultated as they draw in breath again vesicular breathing is heard everywhere." Watson says, "the patient is not necessarily out of breath. It is not dyspnoea that oppresses him; for he can, and generally does, breathe freely and easily." Stokes is decided: "Respiration is _secondarily_ affected; there may be slight dyspnoea or orthopnoea, with lividity of the face, yet by an effort of the will (if the patient dares to encounter the pang this commonly produces) the chest may be pretty freely expanded, and the breathing relieved for a brief space; dyspnoea is not a primary symptom of angina." Eulenburg and Guttmann say, "Our own experience leads us to adopt Parry's conclusion, that the changes in the respiration are principally, perhaps even solely, due to the pain." Bristowe speaks of the sufferer as "fearing to breathe." We can readily see that the "apnæa" observed by Dr. Semple in Cases 1 and 5 had physical origin, but in Case 4 he says "apnæa was extreme; the respiration only occasional--gasping." This shows to what an extreme extent the action of the spider poison had gone--even to implicating the diaphragm; and it is noteworthy that Anstie records a case of angina pectoris (_Neuralgia and its Counterfeits_, p. 67, London, 1871), in which "there was so marked a catching of the breath as to make it almost certain that there was a diaphragmatic spasm."

Of the changes in respiration accompanying angina pectoris we have, then, both the general, and the rarest, form, produced pathogenetically by the poison of _Latrodectus mactans_.

IV.

In its physiological action the poison of _Latrodectus mactans_ resembles angina pectoris vasomotoria--a purely functional derangement. The similitude of the physiological action to pure angina pectoris corroborates the accepted pathology of the latter condition, because the phenomena of _Latrodectus_ poisoning were educed from previously healthy organisms, and in pure angina pectoris there is no pre-existent organic change occasioning the attack. According to the accepted pathology, we have in angina pectoris vasomotoria, sudden spasms of the arterioles; from this an increase of the arterial tension; to overcome this is more forcible and rapid action of the heart; as the arteriole spasm persists and doubtless deepens in intensity, distension of the left ventricle follows, and from overdistension the agonizing breast-pang, and even death from stoppage of the heart's diastole. But we must include another element--spasm of the coronary vessels. "When there is a sudden rise in the blood-pressure in the arteries, due to vasomotor spasm of the peripheral systemic arterioles, and the heart-walls are strong and well nourished, palpitation is evoked; when the coronary branches are involved in the vasomotor spasm then angina is produced, and the heart-walls, acutely distended with blood, can scarcely contract in the face of the opposition presented to their contraction by the high arterial tension. When this sudden systemic arteriole spasm extends to the coronary vessels in a heart whose walls are diseased, a fatal attack of angina with the heart full of blood may be induced. The danger increases with the extent of the structural degeneration of the heart-walls. Sudden rises of blood-pressure in the arteries will tax hearts in their textural integrity, and lead to painful distension; such sudden demands on decayed hearts lead to agonizing angina pectoris, and the sense of impending dissolution is frequently followed by sudden death."

Spasm of the arterioles and coronary vessels, rise of blood-pressure in the arteries, embarrassed action of the heart, and painful distension are just so many consecutive links in the phenomena produced by the poison of _Latrodectus mactans_, as Cases I and IV amply testify.

The spider poisons are akin to the serpent poisons in their property of producing a disorganization of the blood. In Case I, thin and florid non-coagulable blood continued to ooze from the cut surface despite the application of tannin. It may be a question whether this condition of the blood is directly toxicological, or a pathological result of stasis in the peripheral vessels. I incline to regard it as due to the latter condition, and I believe this explanation also holds good in the case of serpent poisoning.

The hæmorrhage recorded in Case I was of gastric origin; splenic congestion existed, and the vasa brevia--branches of the splenic artery--gave way under the pressure. I once met a similar hæmorrhage in a case of intermittent fever in a child, and I recorded the fact as a possible hint for the applicability of _Latrodectus mactans_ in a similar condition.

In all the year that the stray copy of the old magazine was in my possession I felt it a duty to write up this remedy. I have done it lamely, but as well as I was able. Reader, where my duty ends yours begins. May you discharge it more worthily than I.

(There have been a number of cases reported in which _Latrodectus mac._ acted as Dr. Jones predicted; from them we select the following by Dr. E. H. Linnell, _North American Journal of Homoeopathy_, December, 1890):

S. L. G., a man fifty years old, of bilious temperament, a dentist by profession, had slight attacks of angina after severe exposure and overexertion during "the blizzard" in March, 1888. He did not consider them of sufficient importance to consult a physician about them, but some months later he had a suppurative prostatitis, which was followed by considerable prostration, and the attacks of angina became very severe. I never could get a satisfactory description of the character of the pain, and I never saw him during a paroxysm. The pain was brought on by exertion of any kind, and was especially frequent soon after dinner. The pain was sometimes felt in the left arm, but was usually confined to the cardiac region. I once or twice detected a slight aortic obstruction sound, but aside from this failed to find any evidence of organic disease. The usual remedies gave no relief, but _Latrodectus_ [Latin: ezh]c was of great benefit. Under its use the attacks gradually became less frequent and less severe. He has taken no medicine now for at least six months, and he tells me that although he occasionally has a little reminder of his former trouble, the attacks are so slight that he pays no attention to them. I have given the remedy in another similar case, with even more gratifying success. The attacks were very promptly arrested and have not returned, although nearly a year has elapsed. I think we have in this remedy, to which Dr. S. A. Jones directed attention in one of the issues of the _Homoeopathic Recorder_, a very valuable remedy in this painful affection. It is probably, as Dr. Jones suggests, in angina pectoris vasomotoria that it will be found especially serviceable.

LEMNA MINOR.

NAT. ORD., Lemnaccæ.

COMMON NAME, Duckweed.

PREPARATION. The fresh plant is pounded to a pulp and macerated in two parts by weight of alcohol.

(The following is by Dr. Robert C. Cooper, of London, and appeared in the _Hahnemannian Monthly_, 1894):

"The lowest form of phoenogamous vegetation. It consists," says Lindley, "of lenticular floating fronds, composed of stem and leaf together and bearing the flowers in slits in the edge." It forms the green scum found on stagnant ponds and dykes. It is found in two varieties, the _Lemna minor_ and the _Lemna gibba_.

Before going any further I may as well at once make a bald as well as a bold statement, and say that the special province of _Lemna minor_ is to pitch with vigor upon the nostrils; from the very moment I began prescribing it this was beyond question evident. I can think of no possible source of error except that this beneficial action may be due to the germs adhering to the fronds of the _Lemna_ rather than to the pure plant-force.

To guard against this I have carefully filtered my tincture, but this has not made the slightest change in its beneficial influence.

CASE I. Woman aged seventy-four; admission date, September 24, 1892. Nose never clear; breath very unpleasant; for twelve hours nose bled continuously last Christmas; unable to smell properly; hearing for the past seven or eight weeks bad; watch not heard on contact. Prescribed _Lemna minor_ [Greek: theta]A. October 1, 1892: Feeling of cold in nose is better; sense of obstruction nearly gone; can smell better; hears on contact on both sides; no medicine. October 22: Decided, though slight improvement in hearing; nose, throat and all parts around more comfortable. Last attendance.

In proceeding with the consideration of the action of this remedy, I must consider myself fortunate in having the following case to bring forward:

1. A boy of fourteen, whose nose was completely blocked up for the last two years, and whose nostrils were full of polypi, the nose itself being broadened, and in whom the nose had been cleared out by operation a year ago at St. Bartholomew's Hospital, was sent to me by my colleague, Dr. J. H. Clarke. The boy never remembers having smelt anything, and the polypi can easily be seen blocking up both nostrils.

From the 26th of November, 1892, to the 4th of March, 1893, four doses of _Lemna m._ [Greek: theta]A were given at regular intervals without much change, then _Calcarea carbonica_ 200 was given, and two weeks after, as he had faceache, _Mercurius_ 3d dec., and on the 8th of April following the faceache was better but the nose in no way improved.

Then _Lemna_ was given again, and this time with the most pronounced relief; the nose became much clearer, and he went on taking it, and it alone with scarcely an exception, in fortnightly doses, till the 14th of March last, when his nose was quite clear, with none but a very small polypi visible; he could breathe freely and his sense of smell had completely returned.

The delay in the manifestation of remedial change from November to March arose from complete blockage of the nose, and until the space created by the subsidence in the size of the polypi sufficed for a passage of air the patient had no reason to acknowledge relief.

In the treatment, both of swollen tonsils and in that of nasal polypi, the prescriber will be led away at the onset who accepts the testimony of the patient alone; he should make careful inspection of the parts, and be guided by what is often but a slight local change, as well as by concomitant, and it may be remote, symptoms.

2. The next case I have to bring forward is one of ozoena in a girl of sixteen, who had been three years under the treatment of a colleague who kindly sent her on to me for treatment at the London Homoeopathic Hospital. The girl, whose occupation was a teacher, has had ozoena since three or four years old. The odor complained of was horrid, and the discharge excessive; a most unpleasant smell in the nose and nasty taste in the mouth; she takes cold easily if out in the night air or damp, and her nose, at times, gets stuffed up; bowels irregular; catamenia only twice--once three months ago and two months before that.

On December 30, 1893, I prescribed _Lemna minor_, and she returned to me from the country, where she was living, on the 31st of the following March, imploring me for another powder, as she had been almost well for two weeks after the last and then had relapsed to her old state; breathing is short and is low spirited.

21st of April, very much better; odor not nearly so bad, discharge much less; unmedicated pilules, three times a day.

19th of May, 1894, kept better for a month; took cold two weeks ago, and since then throat has felt thick and nose has discharged with a horrid odor. Catamenia regular. Breathing is better; crusts coming from both, worse on the left side. To have _Lemna minor_.

This patient came from a distance which prevented frequent attendance, but the above is quite sufficient evidence of the power possessed by _Lemna m._ in acting upon the nasal mucous membrane.

In both these cases relief was immediate after the administration of the dose, and in neither case could any reasonable doubt exist as to its being drug effect.

In some cases I have known a certain disturbance of the bowels to set in after a dose of _Lemna_, but this effect of the remedy is not sufficiently pronounced to be able to say much about it. Still it is interesting to narrate one or two experiences, especially as in the first of these, at all events, the concomitants were interesting.

3. In a married lady, aged about twenty-six, for whom I prescribed _Lemna m._ [Greek: theta]A on Saturday afternoon, November 12, 1892, and in whom there existed a good deal of catarrhal pharyngitis, due to high up post-nasal ulceration, and who suffered from a dry feeling at the top of the throat with flatulence, and some pain in the bowels toward the evening, described as "twisting" pain, and in whom the nose was blocked on the right side, but without any visible polypus, and in whom the heart was easily disturbed, causing dyspnoea, the bowels being slightly confined.

Two weeks subsequently she stated that after the dose of _Lemna_ the nose felt less blocked, and she felt better in every respect; but that on the Tuesday following diarrhoea set in, which began with twisting pains in the bowels and went on to sickness; continual watery stools. The least chill or nervousness, I must say, upsets her in this way; and she was subject to the same the last two catamenial periods. She still wakes with her throat dry and tongue coated. _Borax_ 2x was then (November 25) given without any noticeable effect, and on the 9th of December _Lemna minor_ [Greek: theta]A was again prescribed for the following symptoms:

Mouth sore after talking or singing, and dry in the morning; tongue coated.

On the 23d of December, reported herself much better; tongue not so coated; heart less disturbed; no indigestion or diarrhoea.

Nose not perfectly clear, but no unpleasant smell or taste as she used to have, and throat no longer dry or uncomfortable. Instead of waking up with a dirty mouth, it feels clean and her taste pure.

4. A man, aged forty-seven, who suffered from old-standing vascular deafness and who specially complained of snoring a great deal, was given _Lemna minor_, and next day a rumbling and disturbance in the bowels set in and he felt as if he had taken medicine of a searching character. This lasted for three days, bowels acting during this time freely with much heat in the passage (anus); but was not bilious, nor were the motions diarrhoeic; the snoring went away, and he ceased to dream unpleasantly when asleep. Hearing, too, seemed somewhat improved.

5. In another case, after a similar dose, diarrhoea came on next day, with pains across the bowels as from flatus; worse after eating, and a very putrid taste with an improvement at the same time in a stuffiness of the nose from which he was suffering.

6. Crusts form in the right nostril and pain like a string extends from the right nostril to the ear of the same side and right ear is deaf. (In a woman, aged twenty-six, great relief.)

It is with great pleasure that I have now to bring forward, not my own observations, but those of two valued colleagues. Dr. J. H. Clarke sends me the following:

_Lemna minor_, CASE I. A lady, aged forty-seven, two years previously met with an accident; a sign board fell on her head when out walking in the street. Seven days after that was taken with sneezing attacks, suffered from nasal catarrh with little intermission until March, 1893, when she came under my care. _Psorinum_ 30 soon put a different complexion on the case, and she became so far relieved of her trouble (which has made her life almost unbearable, as she never dared make an appointment for fear of an attack coming on) that she discontinued treatment. Last Christmas a sharp attack of influenza brought back the catarrh, and this time it proved less amenable to treatment.

Fears of polypus distressed the patient, though I could not discover any.

However, she again made progress, but scarcely as rapid as I could have wished, when I thought of giving her _Lemna_ on indications given by Dr. Cooper.

On February 15, 1894, I gave it in the 3x, one tablet four times a day.

February 22, very much better; has felt freer in the head than at any time during the last ten years; has felt very much better generally; spirits braced up.

She steadily progressed to cure, and by March 15th could endure the smell of strong scented flowers, which before was impossible.

CASE II. Captain B., aged forty-four, consulted me on February 29, 1894, for violent neuralgia on the right side of the neck, the part being exquisitely sensitive to touch. He had cough and cold for a month. On getting up in the morning he filled two pocket handkerchiefs with yellow deflusion before he got his nose clear. I gave him _Bell._ 12 to take till the neuralgia was better, and then told him to take _Lemna_ 3x gtt. j. three times a day.

On March 9th he reported that the _Bell._ speedily took away the neuralgia, and that then the _Lemna_ cleared off the catarrh in a most astonishing fashion. He never had a medicine to act so magically before.

_30 Clarges street, Piccadilly, W., April 21, 1894._